Facial Symmetry Outcomes in Craniofacial Microsomia after Growth Monitoring, Corrective Sur-gery, and Orthodontic Treatment

Abstract

Background: Craniofacial Microsomia (CFM) is a congenital malformation syndrome affecting craniofacial structures derived from the first and second pharyngeal arches. It presents with varia-ble degrees of chin point deviation, mandibular hypoplasia, facial asymmetry, ear anomalies, and soft tissue deficiencies, making classification and treatment challenging. The Kaban classification systems is commonly used to assess severity and guide treatment.Objective: This study evaluates facial symmetry and occlusal outcomes in patients with CFM following staged growth monitoring, surgical interventions, and orthodontic treatments, using the Phenotypic Assessment Tool – Craniofacial Microsomia (PAT-CFM) tool and conventional orthodontic measures. Methods: A single-center retrospective cohort study was conducted at Seattle Children's Hospital Craniofacial Center. Data from 130 patients with CFM were reviewed, with 74 subjects meeting inclusion criteria based on imaging at multiple time points. Growth monitoring outcomes, surgical interventions—including costochondral grafting (CCG), orthognathic surgery, and orthodontic treatments were analyzed to determine their impact on facial asymmetry and occlusion. Results: Forty-five patients with mild CFM (Kaban I and IIa) showed stable or improved chin point deviation, mandibular hypoplasia, and occlusal plane canting over a mean growth period of 4.6–6.0 years. In fifteen moderate to severe subjects (Kaban IIb and III), CCG, orthognathic sur-gery, and/or orthodontic treatment resulted in improved mandibular morphology and occlusal plane alignment, though outcomes varied. Orthognathic surgery combined with orthodontics significantly enhanced facial symmetry and occlusion in severe cases. Conclusion: Data indicated that mild CFM remains stable or improves with growth, while surgical and orthodontic interventions play a crucial role in managing moderate to severe cases. Comprehensive treatment strategies, including CCG and orthognathic surgery, result in improved facial symmetry and occlusal outcomes.